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813-780-0020 City of.Zephyrhills Fire. 1* 8 965 Fax - 813 -780 -0021 <br /> Permit Application <br /> Date Received �oR 1`'IAR f 50/2009 . p Contact g, 3 I ,�j <br /> z ,�c���rsz . ,M _: :.� :.,t,�.•xaa ;< - nv Ctac its- t 3 <br /> hone t for Perm J <br /> Owner's Name 44s�L0 ^ 'A9/ VYTTr Owner's Phone Number S l3 _S / 3 S7 <br /> Owner's Address ?o go q738 38 4/4 "L 33674 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> �'.-.. x' , ?'S'S..aaK• ,,;, ...r z��. tttA:- cs= ,atn_s4 s,..x»,.::<..r ex. _ - -�� ...f> ::.: >.,. ..,.«.. .'t-wx ;.* mss• c ._-« ..:.�:'. -. ra;: r•�#.+.. •s: .,y�.•.,;," .. ,r1�• <br /> Job Address pc' /7 /,JO pi ZZ1' £VSO 67i-LL 7.LVD Lot# <br /> Sub Division Parcel # <br /> qy'e, 44.4 •.tiF'?6k` h4 '4 4 4r$- ...4rffi _%4 ;4V� Ah, •mt o a;" - m. .., a... 4 "44 i > t2& *2>'.. ., x+�. .c.fv- ,kh.4.>>�'<i e..,_ 44 _.i '> ? "N3ri+4 X9. .atI4 .. r 't >94ct!t>44:.? <br /> Bio- Hazard Waste Storage --ANNUAL in Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct ( I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Ii Controlled Bum I I Hood Installation <br /> Emergency Generator < 30 kw - n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> ILttrtyl lsemil FiTi Other <br /> Sprinkler n ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ ( , I I I Sparklers <br /> Hood Cleaning ❑ er ❑ I 1 I I Sprinkler System Installations <br /> Hood Suppression I I ❑ ❑ ❑ I I ( I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> I Fire Works <br /> 1 I Flammable Application- ANNUAL <br /> 1 1 Valuation of Project <br /> I I Fuel Tanks <br /> I Other: 1 I <br /> Contractor Company (/,( yveR_SE S'E /Ci ,s <br /> Signature Registered Y / N Fee Current 1 Y / N <br /> Address 1 I License # I I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current I Y / N j <br /> Address I I License # I I <br /> MECHANICAL I Company <br /> Signature I Piwejester I `i S ti4 it rep to rrertt II 'f i VI jI <br /> Address I <br /> 1 License # I I <br /> OTHER <br /> Company I <br /> Signature Registered Y / N Fee Current I Y / N <br /> Address License # <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />